Barthel Index: what it is, how it is used and what it evaluates
Let's think for a moment about what a great majority of people do day by day since they wake up. We get up, shower and groom, dress, have breakfast, go to work / study, eat ... are seemingly simple activities that we have automated and in which we do not usually stop to think.
But these are basic activities that we all have to do simply to stay healthy and have a certain autonomy, and that we have been learning and developing throughout life.
However, in some cases (accidents, dementias and other neurological diseases, disability ...) It is possible that a person loses the ability to do them himself or that does not get to develop them. Taking into account that these are basic skills, this implies that in order to achieve an adaptive daily functioning the subject will need help to be able to carry them out: it will have a certain level of dependence, either temporarily or permanently.
Assessing when a person is dependent and the degree to which specific help is needed is not as simple as it may seem at first sight, but fortunately there are different assessment instruments that allow us to make such an assessment. One of them is the scale or Barthel Index , of which we are going to talk throughout this article.
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The Barthel Index
It is known as the Barthel Index or the Barthel Scale, which is sometimes also called the Maryland Disability Index, to an assessment instrument in the form of a scale widely used by various professionals in the socio-health branch in order to evaluate or assess the level of independence that a person has when carrying out basic activities.
This measure allows assessing the existence of a physical or neurological disability that supposes a difficulty for the performance and realization of fundamental tasks in our day to day.
Specifically this index value the so-called basic activities of daily life , which are understood as the set of actions and activities that a person needs to do in order to maintain proper self-care and stay healthy and active. That is, unlike other activities that are linked rather to the relationship of the subject with the environment that surrounds it, the basic focuses on how the subject maintains itself.
Not being able to carry out these activities supposes a clear damage to the physical and mental integrity of the subject and could even lead to his death if he is not helped.
The application of the Barthel index, which began to be used in hospitals after 1955, seeks to evaluate how the performance is in a total of ten of these basic activities in such a way that it is observed if the individual can perform them without any problem , need help in a timely manner or is totally dependent on external help.
Your total score (maximum 100 and minimum 0) gives us a general idea of the need for external support, although each of the available items can give us relevant information on what areas or types of activities there are problems or if a specific type of support or another can be provided.
It must be taken into account that this index must be passed at the initial moment in order to assess whether the subject does not present problems in his daily life, but also during and after any rehabilitative intervention that is used. This will allow us to see if this intervention has been successful or not and at what level, as well as adjust the type and level of help provided to the needs of the patient. It is also important to keep in mind that it evaluates what the subject does, not what he could do .
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Basic activities that evaluates
The Barthel Index or Scale evaluates, as we have said, a total of ten basic activities of daily life, which can be divided mainly into food, hygiene, displacement and toilet training. The concrete activities that are observed are the following.
This item assesses whether the subject is able to eat by itself. It involves being able to put food in your mouth, chew and swallow . In addition to this, it is also valued if you are able to perform actions such as cutting food or serving water, although if you can not do these last actions you can eat on your own you will also have a non-zero score (10 if you can do it) all independently, 5 if you need help to cut, use cutlery, etc.). If you need full help to eat, the score is 0.
It is important to keep in mind that what is valued is the act of eating itself: it does not matter for this assessment if the person has cooked the food or someone else has prepared and served it.
2. Washing / personal hygiene
This activity implies being able to maintain body hygiene on its own, so that it can shower and clean itself autonomously.
It also takes into account if you can enter and exit the bathroom. It is assessed if you need help or supervision (0) or if you can do it independently (10) .
Another of the basic activities is dressing. Here it is valued if the subject can put on and take off his clothes autonomously and without help (10 points), it has to be helped in some moments but most things can do it by himself (5 points) or he needs someone to help him at all times (0 points).
This activity implies in part personal grooming, and includes actions such as combing hair, washing face or hands, shaving or putting on makeup . It is assessed whether the subject can do it himself (10) or needs help for it (0).
4. Continence / fecal incontinence
This time we are talking about a basic activity in which the subject eliminates waste from digestion by faecal route. It is assessed if the subject is able to contain feces (10 points), if he has an episode of occasional incontinence or needs help from time to time (5) or if he is unable to control the sphincters by himself, having incontinence as usual (0)
This evaluation is done taking into account the action taken during the week prior to the valuation .
5. Continence / urinary incontinence
In the same way that fecal incontinence is evaluated, the urinary is also assessed.
In this sense, taking into account also the performance in the week prior to the evaluation, it will be observed if the subject can contain the urine and / or take care of the operation of a possible probe (10 points), if it has episodes (maximum 1 daily) of incontinence (5) or if you can not hold urine regularly (0 points).
6. Use of the toilet
Linked to the two previous points, in this case it is valued if the subject is able to use the toilets by himself . If you can go to the bathroom, take off your clothes, perform your needs and clean yourself up with 15 points.
If you need help but can clean yourself, 5 points are valued and if you need help for both aspects, the item will be valued with 0 points.
7. Move to chair or bed
This activity would enter among those that value the capacity of displacement of the subject, specifically if he is able to sit or stand up by himself or enter and leave the bed.
The subject can be totally independent (15 points), need little help (10 points), need someone specialized and with great strength (something that implies that much of the effort he does thanks to such help) to help him although he can remain seated by himself (5 points) or need a total help in which either a crane or several people move him and can not be seated (0 points).
Another of the basic activities that are evaluated in the Barthel Index or Scale is the ability to wander and travel in short distances . It is valued if the subject is able to walk 50 meters without the help of another person or walkers (although you can use crutches or canes). If he is able to independently he scores with 15 points, if he needs help or a walker 10 and if he depends on the help to move he scores with 0.
In the case of people in wheelchairs that can move independently with said chair, it is scored with 5 points.
10. Use stairs
In many of our developments and houses we can find stairs, steps and changes in height, so that being able to use them is considered a basic activity of daily life when traveling.
A subject that can climb or descend stairs autonomously is scored with 10 points on this item, if he needs someone to help or supervise 5 and if he is not able to use the stairs, the item is scored with 0 points.
Score and significance
The Barthel Index or Scale is easy to apply and score . Mainly we must bear in mind that the maximum score is 100 (90 in the case of those who are wheelchair bound) and that each item can be scored with 0, 5 or 10 points. The ten points are awarded when the subject is totally independent for the action referred to in the item, the five when it needs help for specific aspects or when it occasionally has difficulties and the zero points are given when the subject is dependent on said activity.
It should also be borne in mind that some items such as washing or grooming only consist of scores of 5 (independent) or 0 (dependent), and in cases of moving or wandering a score of 15 is added that reflects that the subject can move without help (10 would imply minimal help or supervision).
The score obtained from this scale allows us to obtain an idea of the degree of dependence of the evaluated subject .
Scores of 100 imply total independence, and lower scores would reflect an increasing dependency for activities of daily living.Scores between 100 and 60 indicate the existence of a slight dependence or need for help, between 55 and 40 a moderate dependence, from 35 to 20 we would speak of serious dependence and scores lower than 20 points would indicate that the subject has a total dependence.
- Cid-Ruzafa, J. and Damián-Moreno, J. (1997). Assessment of physical disability: the Barthel index. Spanish Journal of Public Health, 71 (2). Madrid Spain.
- Barrero Solís, C.L., García Arrioja, S. and Ojeda Manzano, A. (2005). Barthel Index (IB): An essential instrument for functional evaluation and rehabilitation. Plasticity and Neurological Restoration, 4 (1-2). International Association for the Advancement of Cerebrality, A.C.